Provider Demographics
NPI:1629542451
Name:PURVIS PHARMACIES, P.C.
Entity Type:Organization
Organization Name:PURVIS PHARMACIES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-635-7931
Mailing Address - Street 1:136 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3713
Mailing Address - Country:US
Mailing Address - Phone:706-635-7931
Mailing Address - Fax:706-635-4334
Practice Address - Street 1:136 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3713
Practice Address - Country:US
Practice Address - Phone:706-635-7931
Practice Address - Fax:706-635-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA514229068AMedicaid